Research In Action

Moderator's note: This post is part of our ongoing series highlighting articles from the "Preventing Unintentional Injuries Among Children and Youth" issue of Pediatric Clinics of North America. Today’s entry, written by Dr. Maneesha Agarwal, features the article "Developmental Considerations for Pediatric Unintentional Injury Prevention". Dr. Maneesha Agarwal is a pediatric emergency medicine physician at Children's Healthcare of Atlanta and Associate Professor of Pediatrics and Emergency Medicine at Emory University School of Medicine. 

Unintentional injuries remain the leading cause of death among children in the United States, yet injury prevention strategies are often approached using broad age-based recommendations, without consideration of how an individual child’s physical, cognitive, social, and behavioral development shapes risk. In our review, we argue that effective pediatric injury prevention must be grounded in an understanding of child development.

Development shapes both children’s exposure to hazards and their ability to recognize and respond to danger. As infants begin rolling, toddlers explore by touching and tasting, school-aged children seek greater independence, and adolescents become more influenced by peers and sensation-seeking, injury risks evolve in predictable but distinct ways. These developmental changes influence not only what injuries occur, but also when and why they happen. For example, toddlers’ exploratory behaviors increase poisoning and fall risks, while adolescents’ developing executive functioning contributes to unsafe driving and recreational risks.

For clinicians, this developmental perspective has practical implications. Anticipatory guidance during well-child visits offers an opportunity to prepare families for upcoming milestones before injuries occur, such as discussing fall prevention before an infant starts rolling or water safety before a toddler becomes mobile. Injury-related visits also create valuable "teachable moments" to reinforce prevention strategies. Established resources such as the American Academy of Pediatrics' The Injury Prevention Program (TIPP) provide developmentally appropriate counseling tools and have demonstrated effectiveness in improving caregiver knowledge, promoting safer behaviors, and reducing childhood injuries.

At the same time, our review highlights the limitations of relying solely on chronologic age. Broad age categories can obscure periods of particularly high risk and fail to account for the social and structural factors that shape injury burden. Children living in poverty, those in rural communities, boys, and racially and ethnically marginalized populations often experience disproportionately higher injury risks. Effective counseling should therefore be individualized, incorporating developmental readiness, family circumstances, and environmental context.

We also emphasize the unique injury prevention needs of children with developmental differences, including autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), intellectual disabilities, and sensory impairments. These children may face increased risks related to wandering, drowning, impulsivity, impaired danger perception, or self-injurious behaviors. Clinicians should proactively address these risks through individualized counseling, environmental modifications, supervision strategies, and community advocacy efforts.

Ultimately, we call for a precision-based, developmentally informed approach to pediatric injury prevention that considers each child's developmental trajectory and lived experience. By integrating developmental science into clinical care, research, product design, health systems, and policy, we can deliver more effective, equitable injury prevention strategies that reflect the realities of children’s developmental trajectories and lived experiences and keep more children safe.